Aug212017

By Aryn Baker

There is no period more critical in a child’s development than its first few months of life, which is why so much attention is paid to what the mother, and the child, eats during that time. Nutritionists like to call it the “golden window” — the slim period of time where a child, if he gets the right nutrients, can set out on a healthy path, or, if he doesn’t, risks irreversible stunting and developmental delays. “Eighty percent of the brain development happens in the first 1,000 days of a child’s life, starting from conception,” says nutritionist Sanjay Kumar Das.

And while getting the right nutrition — whole grains, plenty of fruit and vegetables for both the mother and child, once he starts eating solids — is relatively simple in most situations, conflict can make eating right all but impossible. This is the situation in northeastern Nigeria, where for the past seven years the Boko Haram militant group has waged a violent insurgency that has kept farmers from their fields, food away from markets, and families living off paltry food donations in camps for the internally displaced. While few here in the Dalori camp just outside the northeastern town of Maiduguri display the emaciated limbs and swollen bellies common among victims of outright famine, the little food they do get — a once-daily gruel made of pulses and grains — provides little more than the minimum calorie requirement, and almost no additional nutrition.

An estimated 5.1 million are malnourished in northeastern Nigeria. According to the United Nations’ Children’s Fund [UNICEF], more than half of them are children. Das, who is the nutrition manager for UNICEF's program in Maiduguri, says this is likely to have severe long-term consequences. The impact of acute malnutrition, which happens when a child is suddenly deprived of food, can be reversed relatively easily with emergency food rations and supplements. Chronic malnutrition occurs when a child eats enough to stop from starving, but doesn’t get sufficient nutrients to develop properly, especially in the vital first two years of life. “That golden window is when all a child’s cognitive and physical development happens,” says Das. “If children don’t get good nutrition from an early age, they are vulnerable. The child can suffer from disease and stunting, launching the cycle of poverty.”

Indeed, chronic malnutrition can hinder a nation’s economy. “Stunting early in a child’s life has educational, income, and productivity consequences that reach far into adulthood,” the World Bank writes in its most recent Nutrition Overview.

“Children who are deficient in essential micronutrients have on average 13 fewer IQ points. Similarly, stunted children are more likely to start school later, perform more poorly on cognitive functioning tests, and are more likely to drop out of school.” Adults who were stunted as children earn 20% less than non-stunted adults and are 33% more likely to live in poverty, the report says. It concludes that malnutrition can reduce GDP in some countries in Asia and Africa by as much as 2% to 11% each year.

Which is why organizations like UNICEF and other humanitarian aid agencies place such a high priority on the first 1,000 days, from the point of conception to the child's second birthday. Childhood stunting, once it has set in, cannot be reversed. But it can be prevented.

That’s where good prenatal health and education comes in, says Marylyne Malomba, a nutrition consultant for the International Medical Corps, a humanitarian organization that runs several food and nutrition programs in Maiduguri, which was once at the center of the insurgency, and is now home to some 700,000 people displaced by the war. The IMC provides food, supplements and education for mothers and children in weekly clinics around the city and in several of the camps, with a special emphasis on pregnant women.

“Malnutrition starts from the womb,” says Malomba. “If the mother has not stocked up enough nutrients, then the child will not get enough. Limbs, organs; even brain development is affected by lack of nutrients when the child is still a fetus. So it's important to understand that the health of the mother at the point of pregnancy is one of the most important places to start taking care of the child.” And if a mother is well fed during her pregnancy, she will most likely have enough breast milk to feed her child for the first six months — another key element of early childhood nutrition.

The problem is that in a crisis situation like the one in northeastern Nigeria, or in Somalia, Yemen or South Sudan, other countries on the brink of famine, it is all but impossible for new and pregnant mothers to obtain the vital nutrients that round out the right diet for those first 1,000 days. Emergency food distributions usually include grains, pulses and oil, but fresh vegetables and fruit are too difficult to transport and store. And even if the families could afford to buy fresh produce in the markets, they aren’t always available, especially if conflict is keeping farmers from their fields. “We need these mothers to eat vegetables. We need them to eat fruits," Malomba says. "And these are the items that we are not able to supply in an emergency context.”

Nutritionists and scientists are working to develop supplements that can provide those essential micronutrients for use in future emergencies, but for the moment, nothing beats the fresh fruits and vegetables that are so hard to find in places like Dalori, or the scores of other IDP camps across northern Nigeria.